發(fā)布時間：2018-05-13 21:17

  本文選題：甲狀腺功能亢進癥 + 骨鈣素　； 參考：《河北醫(yī)科大學》2015年碩士論文

【摘要】：目的:觀察初發(fā)Graves病患者骨代謝指標的變化情況,了解初發(fā)甲狀腺功能亢進癥對骨代謝的影響,為糾正骨代謝異常提供臨床依據(jù)。方法:選擇2014年4月—2014年9月河北北方學院附屬第二醫(yī)院門診和住院治療的初發(fā)甲狀腺功能亢進癥患者45例作為實驗組,選擇年齡、性別相對應的健康人44例作為對照組。在相同季節(jié)采用化學發(fā)光微粒子免疫檢測法測定甲狀腺功能(FT3、FT4、TSH)及相關抗體(TPOAb);TRAb測定采用電化學發(fā)光法;應用離子選擇電極法測定血鈣終點法測定血磷;應用電化學發(fā)光法測定骨形成指標骨鈣素(OST)及骨吸收指標β-膠聯(lián)降解產(chǎn)物(β-CTX);采用化學發(fā)光法測定調(diào)節(jié)鈣磷代謝的甲狀旁腺激素(PTH);應用高效液相色譜串聯(lián)質(zhì)譜法測定25-羥維生素D3。采用SPSSl6.0軟件包對所得結果進行統(tǒng)計學分析,計量資料分析使用t檢驗及Mann-Whitney U非參數(shù)檢驗,P0.05有統(tǒng)計學意義。結果:1甲狀腺功能檢查:實驗組FT3及FT4較對照組明顯升高,TSH較對照組明顯降低。實驗組FT3平均值為(23.51±14.63)pmol/L、FT4平均值為(41.08±14.03)pmol/L,對照組FT3平均值(4.32±0.51)pmol/L、FT4平均值(15.71±1.82)pmol/L,P值0.001;實驗組TSH(0.003±0.013)u IU/ml,對照組TSH(2.132±1.027)u IU/ml,P值0.001;2甲狀腺相關抗體檢查:實驗組TRAb及TPOAb較對照組明顯增高。實驗組TRAb平均值(12.99±8.39)IU/L、TPOAb平均值(558.46±420.14)IU/ml,對照組TRAb平均值(0.95±0.31)IU/L、TPOAb平均值(11.52±9.74)IU/ml,P值0.001;3血鈣磷檢查:實驗組血鈣磷較對照組明顯增高。實驗組游離鈣平均值(1.25±0.07)mmol/L,對照組游離鈣平均值(1.18±0.08)mmol/L,P值0.001;實驗組血磷平均值(1.26±0.19)mmol/L,對照組血磷平均值(1.22±0.12)mmol/L,P值0.05;4成骨及破骨細胞的指標:實驗組OST及β-CTX較對照組明顯增高。實驗組OST平均值(48.62±19.92)ng/ml,對照組OST平均值(14.02±3.75)ng/ml,P值0.001;實驗組β-CTX平均值(0.981±0.418)ng/ml,對照組β-CTX平均值(0.445±0.268)ng/ml,P值0.001;5 PTH測定結果:實驗組較對照組明顯降低。實驗組PTH平均值(2.64±1.36)pmol/L,對照組PTH平均值(3.12±1.37)pmol/L,P值0.05;6 25-羥維生素D3測定結果:實驗組較對照組明顯降低。實驗組25-羥維生素D3平均值(17.60±7.85)ng/ml,對照組25-羥維生素D3平均值(23.55±7.87)ng/ml,P值0.05。結論:1甲狀腺功能亢進癥患者較健康對照人群相比游離血鈣及血磷明顯增高;2甲狀腺功能亢進癥患者的骨形成及骨吸收均較健康人群活躍;3甲狀腺功能亢進癥患者PTH及25-羥維生素D3水平較健康人群明顯降低。
[Abstract]:Objective: to observe the changes of bone metabolism in patients with primary Graves disease, and to understand the effect of primary hyperthyroidism on bone metabolism, and to provide clinical basis for correcting abnormal bone metabolism. Methods: from April 2014 to September 2014, 45 patients with primary hyperthyroidism were selected from outpatient and inpatient treatment in the second affiliated Hospital of Hebei North University as experimental group, and 44 healthy persons corresponding to age and sex were selected as control group. In the same season, the thyroid function FT3FT _ 4T _ 4T _ (SHH) and the relative antibody TPO _ (Ab) TRAB were detected by chemiluminescence microparticle immunoassay, and the serum phosphorus was determined by ion selective electrode method by the end point method of blood calcium, and by electrochemiluminescence (ECL). Bone formation index osteocalcin (OST) and bone resorption index 尾 -gel degradation product (尾 -CTX) were determined by electrochemiluminescence (ECL), parathyroid hormone (PTH), a parathyroid hormone (PTH), which regulates calcium and phosphorus metabolism, and 25-hydroxyvitamin D _ (3) was determined by high performance liquid chromatography tandem mass spectrometry (HPLC / MS). The results were analyzed by SPSSl6.0 software package, and the data were analyzed by t test and Mann-Whitney U nonparametric test (P0.05). Results: FT3 and FT4 in the experimental group were significantly higher than those in the control group. The average FT3 of experimental group was 23.51 鹵14.63 渭 mol / L FT _ 4 = 41.08 鹵14.03 渭 mol 路L ~ (-1), FT3 of control group was 4.32 鹵0.51 渭 mol / L ~ (-1) 渭 mol / L ~ (-1) FT _ 4 = 15.71 鹵1.82 渭 mol / L ~ + P = 0.001, TSH(0.003 鹵0.013 渭 mol / L ~ (-1) 渭 mol / L ~ (-1) TSH(0.003 of control group and control group (TSH(2.132 鹵1.027 U 路ml ~ (-1) 路L ~ (-1); TRAb and TPOAb in the experimental group were significantly higher than those in the control group. The average value of TRAb in the experimental group was 12.99 鹵8.39 渭 mol / L, the mean value of TRAb was 558.46 鹵420.14 渭 mol / ml, and the average value of TRAb in the control group was 0.95 鹵0.31. The mean value of serum calcium and phosphorus was 11.52 鹵9.74U / ml / ml P 0.001g / ml: the blood calcium and phosphorus in the experimental group was significantly higher than that in the control group. The mean value of free calcium in the experimental group was 1.25 鹵0.07 mmol / L, in the control group was 1.18 鹵0.08 mmolL / L P 0.001, in the experimental group was 1.26 鹵0.19 mmol / L, and in the control group, the mean value of serum phosphorus was 1.22 鹵0.12 mmol / L / L, 0.054 mmol-1 / L, respectively. The levels of OST and 尾 -CTX in the experimental group were significantly higher than those in the control group. The average value of OST was 48.62 鹵19.92 ng / ml in the experimental group and 14.02 鹵3.75 ng / ml / ml in the control group (P = 0.001), while the average value of 尾 -CTX in the experimental group was 0.981 鹵0.418 ng / ml, and the average value of 尾 -CTX in the control group was 0.445 鹵0.268 ng / ml respectively. The results showed that the average value of 尾 -CTX in the experimental group was significantly lower than that in the control group. The average value of PTH was 2.64 鹵1.36 mmol / L in the experimental group and 3.12 鹵1.37 mmol / L in the control group. The results showed that the mean value of PTH in the experimental group was 0.05 鹵1.36 渭 mol / L, and the value of hydroxyvitamin D3 in the experimental group was significantly lower than that in the control group. The mean value of 25-hydroxyvitamin D _ 3 was 17.60 鹵7.85 ng / ml in the experimental group and 0.05 in the control group (23.55 鹵7.87 ng / ml, P < 0.05). Conclusion the bone formation and bone resorption in hyperthyroidism patients with 1 / 1 hyperthyroidism were significantly higher than those in healthy controls, compared with free blood calcium and serum phosphorus in hyperthyroidism patients with hyperthyroidism, both bone formation and bone resorption in hyperthyroidism patients were more active than those in healthy controls. The levels of PTH and 25-hydroxyvitamin D 3 were significantly lower than those of healthy subjects.
【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R581.1

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